Dialectical Behavior Therapy (DBT) in Florida: Building Skills for Life’s Hardest Moments

For some people, emotions are not just intense; they are overwhelming. Feelings arrive quickly, hit intensely, and seem to last much longer than those of other people. Trying to think positively, just breathe, or “let it go” does not appear to be enough to manage the scale of what they are going through. Dialectical behavioral therapy (DBT) was developed exactly for this.

DBT is not meant to tell you that your emotions are wrong, or that you should simply think differently, but instead teaches you to acknowledge that your emotional experience is legitimate and true, and then provides a set of learnable, effective skills to manage it. At Agape Behavioral Health in Florida, DBT is one of the most popular and widely used forms of therapy as part of a comprehensive treatment program for individuals struggling with some of the most challenging mental health conditions we treat.

Dialectical behavior therapy (DBT), developed in the late 1980s by Dr. Marsha Linehan, is a specific, evidence-based form of psychotherapy that was initially developed to treat borderline personality disorder (BPD), a condition characterized by emotional dysregulation, unstable interpersonal relationships, and frequent episodes of self-destructive or suicidal behavior.[1]  DBT has since been found useful in treating a wide variety of disorders associated with emotional dysregulation, including substance use disorders, eating disorders, and other complex conditions.[2]

The term “dialectics” refers to the ongoing relationship between acceptance and change.[3] DBT believes that both acceptance and change are required for meaningful growth, and recognizes that only when both are acknowledged together will progress happen. Clients are accepted for who they are and where they are; their pain is valid, their struggles make sense, and at the same time, change is possible; skills can be taught, and a worthwhile life can be built. This “both/and” approach makes DBT distinct from change-oriented therapies alone and allows it to effectively help people who have previously felt misunderstood or dismissed by past treatments.

DBT can be delivered through individual therapy sessions, DBT skills group sessions, and between-session support. At Agape Behavioral Health, DBT is incorporated into overall treatment plans and administered by trained DBT therapists within an individualized treatment plan.

DBT works by teaching four interdependent modules of skills that are the primary areas of difficulty for people with emotional dysregulation. The four modules are not theoretical constructs — they are functional, practical tools that clients learn, practice in the DBT skills group, and apply during their day-to-day lives outside of sessions. Through diary cards, clients monitor their skill use and emotional patterns, allowing both the client and their DBT therapist to assess progress, identify areas requiring additional attention, and adjust treatment accordingly.

Mindfulness 

Mindfulness is the foundational skill upon which all DBT skills rely. Mindfulness is the ability to perceive and describe one’s own current internal states, thoughts, feelings, and bodily sensations, without judgment or reaction to them. In DBT, mindfulness is not viewed as a technique for relaxation, but as a practical tool that creates a gap between a stimulus and a person’s response to it, making it possible for that person to choose how they respond to a situation rather than reacting automatically. Mindfulness also serves as the base for validation, a key component of the DBT model that enables the therapist to clearly communicate their understanding of the client’s experience.

Distress Tolerance

Distress tolerance techniques in DBT are intended for periods of acute emotional crisis, when the intensity of an experience feels unbearable and there is significant risk that someone will engage in impulsive behaviors that could result in harm. Rather than reducing distress levels, these techniques enable people to endure these crisis situations without making things worse. 

Examples of distress tolerance techniques include self-soothing, radical acceptance, distraction, and TIPP techniques (Temperature, Intense Exercise, Paced Breathing, Paired Muscle Relaxation), all practical and accessible tools for riding out the intense emotions safely.

Emotion Regulation

DBT’s emotion regulation module deals with the longer-term work of developing awareness of, learning to manage, and ultimately changing the emotional patterns that cause distress. Skills taught include identifying and labeling emotions accurately, understanding the function of those emotions, reducing vulnerability to emotional dysregulation, and creating positive experiences to counteract chronic low moods. 

People dealing with depression, anxiety, bipolar disorder, or post-traumatic stress disorder (PTSD) will typically find this module to be the core of their DBT work.

Interpersonal Effectiveness

DBT’s interpersonal effectiveness module focuses on relationship challenges that can stem from emotional dysregulation, including difficulties with asking for what one needs, saying no, maintaining self-respect during conflicts, and preserving relationships without compromising one’s own well-being. Extensive role-playing is included in this module to provide a safe environment where clients can practice communicating in new ways before doing so in real-life situations.

Although DBT was initially developed to treat people diagnosed with borderline personality disorder (BPD), its application has grown significantly as research has proven its effectiveness across a variety of conditions. 

DBT may be the right choice for you if you are managing:

• BPD and other personality disorders characterized by emotional dysregulation
• Depression that does not respond adequately to other forms of treatment, especially when emotional instability or self-harm are present
• Anxiety disorders — when emotional dysregulation worsens the cycles of fear and avoidance
• Post-traumatic stress disorder (PTSD) — including trauma-informed DBT adaptations that focus on the emotional dysregulation experienced by individuals with PTSD
• Eating disorders — when DBT’s emotion regulation and distress tolerance skills help reduce the emotional motivation for disordered eating behaviors
• Substance use disorders — when DBT provides alternative methods for coping with stress and emotional pain, reducing the likelihood of relapse
• Attention-deficit hyperactivity disorder (ADHD) — when emotional impulsivity and interpersonal challenges benefit from DBT’s skills-based approach
• Bipolar disorder — when DBT’s emotion-regulating skills support both mood stability and medication adherence
• Suicidal ideation and self-destructive behavior — DBT was specifically developed for this and has the strongest evidence base for treating these behaviors.[4]

Many people, especially those with BPD, self-harm histories, or recurrent suicidal ideation, have been told that their emotions are “too much” so many times that they carry shame alongside their ongoing distress. 

DBT validates what they’re going through. It asserts that a person’s emotional experience is understandable based on their history and biology, even when those feelings lead to behaviors that need to change. The validation provided in DBT is not permissive; it is the foundation for therapy that allows individuals to view change as a possibility rather than just another form of rejection.